Linda Gromko, MD is a family physician whose husband, Steve Williams, received five Home Hemodialysis treatments per week beginning in 1/08. He switched to Home Peritoneal Dialysis in 1/11. Sadly, Steve died in April 2011 - one week after a leg amputation. Dr. Gromko's blog explores issues of treating Renal Failure at home, making the treatments more user-friendly, and supporting the all-important caregiver in the family on Home Dialysis.

Tuesday, December 29, 2009

Steve gets a Primary Care Provider--at Last!

Yesterday, Steve and I went to visit his new Primary Care Provider, Internist Therese Law, MD. His prior Primary Care Provider had left for a teaching position at the University of Washington--leaving a gap in his care. We were both very happy with the visit. Dr. Law was kind, highly professional, very knowledgeable, and - best of all - undaunted by Steve's medical history.

Steve's medical record is the size of a New York City telephone directory, and it's complicated. I've been saying for years that I should get Continuing Medical Education credits just for being his wife! (I have learned a tremendous amount of medicine just by being with him - more internal medicine and nephrology than I ever imagined. Plus, I learned how to run hemodialysis!)

So why, with a nephrologist, a cardiologist, an ophthalmologist, a hematologist, an orthopedist, a transplant nephrologist, a transplant surgeon all in Steve's camp, does he need a Primary Care Internist?

Allow me to climb onto my soapbox....

First of all, let's define what a Primary Care Provider is. Primary Care physicians who treat adults only are called "Internists," or "Internal Medicine" doctors. Family Practitioners - like me - are trained to care for people of all ages: from infants to the elderly. We are also trained to deliver babies, although I stopped delivering babies several years ago. Pediatricians, also Primary Care physicians, treat children from infants to adolescents.

Primary Care Providers are board certified after completing a three-year residency program after medical school. Specialist physicians are usually Internists who then go on for additional training in their particular area of expertise. Surgeons go through surgical residencies after medical school; they, too, may specialize after specialty training - or practice as general surgeons.

So, what does a Primary Care Provider have to offer?

I like the explanation that PCPs are experts in common health problems, who are trained to recognize more serious conditions, and refer patients for more involved treatment to our specialist colleagues.

PCPs are often a patient's initial diagnostician.

PCPs tend to be good "scanners," focusing on the "big picture" rather than a single area.

PCPs tend to offer "breadth" of knowledge, while specialists offer more "depth" of knowledge.

A good PCP can help you by being an effective "broker." (I can find you a specialist in hair loss for women, for example, or a transgender-friendly gastroenterologist in a heartbeat!)

PCPs can help coordinate a patient's care, and facilitate good communication between the different care providers.

A good PCP can be very helpful in facilitating behavioral change, i.e. smoking cessation, alcohol treatment, etc.

Your PCP is likely the advocate who keeps you on track with health screening: reminding you of mammograms, colonoscopies, DEXA scans, immunizations, and the like.

A PCP who knows you over a long period of time may know you better: making the PCP an excellent resource for problem solving, particularly for serious matters like end of life issues.

Does everyone need a Primary Care Provider?
In my opinion, yes! Am I biased? Absolutely! I've just seen so many examples where PCPs have added invaluable contributions to patients' overall health. I certainly don't have the expertise that Steve's specialists do, but few of them would likely feel comfortable in my practice either!

Remember, it can take titme to find the right doctor - or doctors - for you and your family. But it's well worth the effort.

2 comments:

Linda,As a physician, do you have a PCP for yourself? My physician husband doesn't and I worry that he has no outside person to consult when he gets sick. He seems to think he can handle everything himself.

Miriam, thank you for the comment. I do have a PCP: a Family Physician who trained in my program, but two years ahead of me. There's a saying that "A doctor who treats himself has a fool for a patient." This raises some great caregiver issues, too. I'll have to blog about this...Happy New Year, Miriam! Linda